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General NPI Number Information
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NPI Number | 1790485621
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Entity Type | Individual
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Provider Name | KODJO SENIOR EDOH RN
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Gender | Male
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 8623 E 32ND ST N
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City | WICHITA
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State | KS
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Zip | 67226-3317
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Country | US
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Telephone | 316-869-2888
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Fax | 316-425-5550
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Provider Business Mailing Address
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Address Line | 5500 E KELLOGG DR
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City | WICHITA
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State | KS
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Zip | 67218-1607
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Country | US
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Telephone | 208-571-8623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 150820
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 83479
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License Number State | KS
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